title: International trends in surgical treatment of rectal cancer.
abstract: BACKGROUND
  Surgical technique might influence rectal cancer survival, yet international practices for surgical treatment of rectal cancer are poorly described.
  
  
  METHODS
  We performed a cross-sectional survey in a cohort of experienced colorectal surgeons representing 123 centers.
  
  
  RESULTS
  Seventy-one percent responded, 70% are from departments performing more than 50 proctectomies annually. More than 50% defined the rectum as "15 cm from the verge." Seventy-two percent perform laparoscopic proctectomy, 80% use oral bowel preparation, 69% perform high ligation of the inferior mesenteric artery, 76% divert stomas as routine for colo-anal anastomosis, and 63% use enhanced recovery protocols. Different practices exist between US and non-US surgeons: 15 cm from the verge to define the rectum (34% vs 59%; P = .03), personally perform laparoscopic resection (82% vs 66%; P = .05), rectal stump washout (36% vs 73%; P = .0001), always drain after surgery (23% vs 42%; P = .03), transanal endoscopic microsurgery for T2N0 in medically unfit patients (39% vs 61%; P = .0001).
  
  
  CONCLUSIONS
  Wide international variations in rectal cancer management make outcome comparisons challenging, and consensus development should be encouraged.
authors.affiliation: Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
authors.forename: Knut M
authors.initials: KM
authors.lastname: Augestad
authors.forename: Rolv-Ole
authors.initials: RO
authors.lastname: Lindsetmo
authors.forename: Harry
authors.initials: H
authors.lastname: Reynolds
authors.forename: Jonah
authors.initials: J
authors.lastname: Stulberg
authors.forename: Anthony
authors.initials: A
authors.lastname: Senagore
authors.forename: Brad
authors.initials: B
authors.lastname: Champagne
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Heriot
authors.forename: Fabien
authors.initials: F
authors.lastname: Leblanc
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D044362:Australasia / Q000453:epidemiology; D003106:Colon / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods* / Q000639:trends*; D032921:Consensus; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007391:International Cooperation; D010535:Laparoscopy; D008297:Male; D008866:Microsurgery / Q000295:instrumentation; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome